Dentist Blog

Posts for tag: Dental Implants

Dental implants are known for their durability as well as life-like beauty. Thanks to their unique construction and ability to integrate with bone, they have a very high success rate and can last for decades.

But while they’re less problematic than other restorations, we still can’t “set them and forget them.” While the implants themselves aren’t susceptible to disease, the supporting gums, bone and adjacent teeth are. If you want them to last as long as possible, you’ll need to care for them and the rest of your mouth through daily oral hygiene and semi-annual office cleanings.

With that said, there are a few differences in how we perform hygiene tasks with implants. This is due to the way in which they attach to the jaw, as the titanium post is inserted directly into the bone. Natural teeth, on the other hand, are held in place by the periodontal ligament, a strong connective tissue that lies between the teeth and bone. The ligament holds the teeth firmly in place while also allowing minute tooth movement in response to changes in the mouth.

The ligament also has an ample blood supply that assists with fighting infection that may arise in the tooth and its supporting gums. Without this extra source of defense, infections that arise around an implant can grow quickly into a condition known as peri-implantitis and lead to rapid bone loss that could cause the implant to fail.

That’s why you and your hygienist must be ever vigilant to the buildup of plaque, the bacterial film that gives rise to dental disease, around implants and adjacent teeth. This includes removing plaque buildup from implant surfaces, although your hygienist will use tools (scalers or curettes) made of plastic or resin rather than traditional metal to avoid scratching the implant’s dental material. They’ll likewise use nylon or plastic tips with ultrasonic equipment (which uses high vibration to loosen plaque) and lower power settings with water irrigation devices.

Keeping infection at bay with effective hygiene is the number one maintenance goal with dental implants. Doing your part along with your hygienist will help you get the most of this investment in your smile.

With a 95-plus percent survival rate after ten years, dental implants are one of the most durable replacement restorations available. Implants can potentially last much longer than less expensive options, which could make them a less costly choice in the long run.

But although a rare occurrence, implants can and do fail—often in the first few months. And tobacco smokers in particular make up a sizeable portion of these failures.

The reasons stem from smoking’s effect on oral health. Inhaled smoke can actually burn the outer skin layers in the mouth and eventually damage the salivary glands, which can decrease saliva production. Among its functions, saliva provides enzymes to fight disease; it also protects tooth enamel from damaging acid attacks. A chronic “dry mouth,” on the other hand, increases the risk of disease.

The chemical nicotine in tobacco also causes problems because it constricts blood vessels in the mouth and skin. The resulting reduced blood flow inhibits the delivery of antibodies to diseased or wounded areas, and so dramatically slows the healing process. As a result, smokers can take longer than non-smokers to recover from diseases like tooth decay or periodontal (gum) disease, or heal after surgery.

Both the higher disease risk and slower healing can impact an implant’s ultimate success. Implant durability depends on the gradual integration between bone and the implant’s titanium metal post that naturally occurs after placement. But this crucial process can be stymied if an infection resistant to healing arises—a primary reason why smokers experience twice the number of implant failures as non-smokers.

So, what should you do if you’re a smoker and wish to consider implants?

First, for both your general and oral health, try to quit smoking before you undergo implant surgery. At the very least, stop smoking a week before implant surgery and for two weeks after to lower your infection risk. And you can further reduce your chances for failure by practicing diligent daily brushing and flossing and seeing your dentist regularly for cleanings and checkups.

It’s possible to have a successful experience with implants even if you do smoke. But kicking the habit will definitely improve your odds.

If you're considering dental implants, they'll need to be surgically placed in the jaw bone. But don't be alarmed — it's a relatively minor procedure that usually requires nothing more than local anesthesia.

But that being said, it's still an invasive procedure that involves making incisions in gum and bone tissues. That could introduce bacteria into the bloodstream and pose, for certain individuals, a slightly greater risk of infection.

But infection risk is quite low for most healthy patients. As a result, implants enjoy a greater than 95-percent success rate ten years after installation. But some patients have health issues that increase their risk of infection. These include older adults with a weakened immune system, smokers, diabetics or those well under or over their ideal weight.

If you have these or similar health situations, we may recommend undergoing an antibiotic treatment before you undergo surgery. This can help prevent bacteria from spreading and reduce the likelihood of an infection.

Preventive antibiotic therapy is commonplace with many other dental procedures. Both the American Dental Association and the American Heart Association recommend antibiotics before any invasive oral procedure for patients with prosthetic (false) heart valves, past endocarditis, a heart transplant or other heart conditions. To lower the risk of implant failure due to infection, we often advise antibiotics for patients who fall in these categories, as well as those with similar conditions mentioned earlier.

Of course, whether pre-surgical antibiotics is a wise choice for you will depend on your medical history and current health status. We'll consider all these factors thoroughly before advising you. But if you are more susceptible to infection, antibiotics before surgery could potentially lower your risk for an implant failure.

If you've lost a tooth, you have a number of options for replacing it. Perhaps the best choice in terms of lifelikeness and durability is a dental implant.

All implants have the same basic architecture: a titanium metal post imbedded in the jawbone to replace the root; and an abutment, a metal collar that links the post with a lifelike porcelain crown. But implants can vary in how the crown attaches to the abutment and post — either cemented to the abutment or screwed through the abutment to the post.

Either method will permanently secure the crown to the implant. But there are advantages and disadvantages for each.

A screw-retained crown may better facilitate any future repair that might be needed. For a skilled dentist it's a simple matter of removing the screw and then the crown from the abutment. There's less risk of damage to the implant during repairs or crown replacement. Many dentists also prefer screws for crowns placed at the same time they're installing the implant post (a procedure called immediate loading).

The screw access hole, however, could pose a cosmetic problem. Although we can cover it over with tooth-colored filling, it may still be noticeable and unattractive especially for a tooth visible when you smile (in the smile zone). There's also the possibility the porcelain around the access hole could chip.

By contrast, cemented crowns have a smooth, unbroken surface and are aesthetically ideal for smile zone teeth. But the cement could interact poorly with gum and bone tissue in some patients, causing inflammation and possible bone loss.

And unlike screw-retained crowns, cemented crowns are difficult to remove for implant repair. We may have to drill through the crown to access the screw between the abutment and the post, and then repair it cosmetically if we use the same crown. Again, the final result may not be quite as visually appealing.

In the end, it will depend on the implant's location, how your body reacts to the cement or your dentist's preference. In either case, though, you'll have a tooth replacement that's functional, life-like and able to endure for many years to come.

Some patients who wear dentures face a kind of Catch-22: their denture fit may have loosened and become uncomfortable over time due to continued bone loss, yet the same bone loss prevents them from obtaining dental implants, a superior tooth replacement system to dentures.

But there may be a solution to this dilemma that combines the stability of implants with a removable denture. A set of smaller diameter implants — “mini-implants” — can support a removable denture with less bone than required by a conventional implant.

Like all living tissue, bone has a life cycle: after a period of growth, the older bone dissolves and is absorbed by the body, a process known as resorption. The forces generated when we bite or chew are transmitted by the teeth to the jawbones, which stimulates new bone formation to replace the resorbed bone. When the teeth are lost, however, the stimulation is lost too; without it, resorption will eventually outpace bone growth and repair, causing the bone mass to shrink.

Removable dentures also can’t supply the missing stimulation — bone loss continues as if the dentures weren’t there; and due to the compressive forces of a denture, bone loss accelerates. As the jawbone structure used to originally form the denture’s fit eventually shrinks, the denture becomes loose and difficult to wear. It’s possible to adjust to the new jaw contours by relining the dentures with new material or creating a new set of dentures that match the current bone mass. Without adequate bone, fixed crowns or bridges anchored by conventional implants may also be out of the picture.

On the other hand, mini-implants with their smaller diameter need less bone than the traditional implant. A few strategically placed within the jaw are strong and stable enough to support a removable denture. One other advantage: these mini-implants can be installed in one visit with local anesthesia and usually without the need for incisions or stitches.